Just like braces for crooked teeth, the video explains, this cosmetic surgery is "simple, safe and effective." But this is no orthodontia. For $5,900 and a mere 55 minutes of time, the surgeon in the video promises to substantially lengthen and widen a patient's penis.

Like the beginning of breast augmentation in the 1970s, penile enlargement has become a hot new cosmetic specialty -- and nowhere is it more prevalent than here in the nation's plastic-surgery capital. Popularized only during the past few years, penile enlargement is now a major profit center for some enterprising urologists and plastic surgeons whose incomes have fallen with managed care. The fledgling industry has grown quickly even though the procedure is unregulated, isn't taught by any university, can be dangerous -- and doesn't always work.

Toll-Free Advice

Cosmetic Surgery International says its two surgeons together perform 30 to 45 enlargements each week and are booked through July. One Southern California clinic reported revenue averaging more than $1 million a month. Several medical groups advertise toll-free numbers, like 1-800-SURGEON in Beverly Hills, which accepts Visa and MasterCard and has operators ready to explain the $7,000 procedure to callers in Thai, German, Vietnamese, Swedish or French. "I cannot physically talk to everyone with interest out there," says Rodney Barron, a Beverly Hills urologist who has opened sales offices in San Francisco, San Diego, Orange County and Los Angeles and says he has performed more than 3,000 enlargements.

Nationwide, some 20 to 30 surgeons now practice phalloplasty, as the procedure is known; about half are clustered in Southern California. Based on individual surgeons' estimates of their patient caseloads, the industry brings in at least $24 million a year -- a fraction of the estimated $350 million a year breast-implant business, but a fast-growing industry nonetheless.

All this despite the fact that the American Urological Association and the American Society for Aesthetic Plastic Surgery both say the surgery has "not been shown to be safe or efficacious." To the extent that the public hears about the usually hush-hush procedure at all, it is because of terrifying news reports of botched jobs and complications, ranging from scarring and lumpiness to impotence and even death. A high-profile surgeon in Los Angeles has been slapped with dozens of malpractice suits, while another in Miami is in prison for the death of a patient.

New 'Outlook on Life'

Yet especially here in Southern California, where a culture of vanity prevails, new recruits to the surgery are easy to find. Cosmetic surgery in general is more popular here than anywhere else in the country. In 1994, the latest year figures are available, 84,300 cosmetic surgeries were performed in California -- 21% of all U.S. cosmetic surgeries, and more than double the number performed in second-place Florida, according to the American Society of Plastic and Reconstructive Surgeons.

"I never felt comfortable or confident about myself before," says Frank Whitehead, a Los Angeles entrepreneur who had an operation to both lengthen and widen his penis last year. Sitting in the office of his printing shop in the San Fernando Valley, Mr. Whitehead, a tall, affable man with a black mustache and tufts of black hair peeking through a plaid shirt unbuttoned to his navel, says that the procedure "has changed my whole outlook on life."

"I go out on a limb more than I did before with business," he says. "Now [when] I go into business meetings, I'm thinking, 'If you guys had just half of what I have.' "

Southern Origins

How penile enlargement became so popular here is a tale more of marketing than medicine. In the late 1980s, a Miami physician named Ricardo Samitier, who had created a niche for himself by performing silicone lip enlargements, decided to apply his trade to penises. The result was a penis-widening operation in which he injected fat extracted from the abdomen or other parts of the body.

Meanwhile, half a world away in China, a surgeon named Long Daochao had invented a procedure to lengthen the penis; his new technique was brought to the U.S. in 1991 by another Miami physician, urologist Harold Reed. The lengthening procedure involves severing a ligament that attaches the penis to the pubic bone, allowing the internal portion of the organ to drop to the exterior.

For a while, Dr. Samitier dominated the fledgling field. But his reign was cut short after one of his patients, a 47-year-old lounge singer who had been on blood-thinning medication, died following the operation in 1992. Dr. Samitier is now serving a five-year prison sentence for manslaughter.

That's when Los Angeles urologist Melvyn Rosenstein stepped in. Dr. Rosenstein, now 57, had performed a handful of enlargements in 1993 when he teamed up with marketing expert Ed Tilden, who had promoted a Beverly Hills hair-transplant center and who saw a marketing gold mine in penile surgery.

Together, the two men opened the Men's Institute of Cosmetic Surgery. It advertised penile enlargements heavily in national magazines like GQ and Penthouse as well as in local newspaper sports pages, with this slogan: "Dreams do come true." Dr. Rosenstein, tall and garrulous, appeared in the ads as well as in his own promotional video. He eagerly offered up quotes to reporters, telling them that his clients included "a major movie star," two famous singers, and "CEOs you read about in Forbes." He declined to comment for this piece.

The marketing machine worked, spectacularly. Soon, the two men set up satellite offices in more than a dozen cities, including Phoenix, Houston, Baltimore and New York. The offices were staffed by young men who, former associates say, frequently had no medical background and who were paid $4,000 a month to explain the procedure to prospective patients. The patients were then referred to Dr. Rosenstein's Culver City, Calif., clinic, where he performed six to 14 surgeries a day. In Los Angeles County Superior Court papers, he reported that the clinic's revenue totaled $7.4 million for the first six months of 1994. Dr. Rosenstein and Mr. Tilden have since had a falling out and are in litigation.

Dr. Rosenstein's business was such a success that other surgeons quickly joined in. Many simply read or heard about the procedure and then set up shop with no experience. They had little choice; there were few physicians they could turn to who would teach them. "Most of those guys don't want to teach anybody else because it means giving up business," says Gary Alter, a Beverly Hills urologist and plastic surgeon who performs the procedure.

For some surgeons feeling the pinch of managed care, the procedure was a godsend. "Unfortunately, many doctors have target incomes, and when they see their incomes dropping down, they start elective surgery," says Miami's Dr. Reed, who believes some of the surgeons aren't performing the operation properly. "So a cottage industry starts to develop."

Soon, Los Angeles sports pages were filled with ads for the likes of 1-800-SURGEON, Surgery Center for Men, the Barron Centers, 1-800-680-MALE and the Southern California Specialists in Sexual Medicine. Some ads promised as much as a 30% to 50% increase in width and a two-inch increase in length. Fortuitously, the World Wide Web was exploding at just this time, allowing the California surgeons to tout their expertise all over the world.

Little Oversight

The surgeons were able to ply their new trade with little oversight. While other new medical procedures are backed up by extensive research and scientific studies, no comprehensive studies have yet been completed on penile enlargement. The Food and Drug Administration, which oversees breast implants, doesn't monitor the surgery because no implant or drug is involved. Hospitals must approve new procedures, but most phalloplasty surgeons perform the operations in their offices or in private clinics.

Nor do state authorities get involved unless they receive complaints about individual surgeons, says California Deputy Attorney General Elisa Wolfe. "We're not looking at the procedure itself," she says. "Experimental surgery is not illegal. We cannot take on an industry."

Free from regulation, the industry exploded into a marketing phenomenon. Currently, there are well over 30 web sites devoted to penile enlargement. While no official figures exist, surgeons estimate that 10,000 to 15,000 widening or lengthening surgeries have been performed in the U.S. since the early 1990s. Surgeons try to outdo one another with slick promotional materials, including, on the web sites, impressive before-and-after pictures.

Complaints Pile Up

One thing most of the promotional literature doesn't mention: the dangers of the surgery. Soon after Dr. Rosenstein began performing phalloplasty, complaints began piling up against him and his center.

Ron Nance, 47, a carpenter from Monterey, Calif., says that following 1994 surgery performed by one of Dr. Rosenstein's associates, he got a severe infection. He says he had to fly back to Los Angeles, and that Dr. Rosenstein opened up the incision without giving him an anesthetic. On the plane back home that afternoon, Mr. Nance says he noticed the stitches were coming out again. The complications persisted, and Mr. Nance says he flew to Los Angeles a total of nine times for repairs before turning to other surgeons for help. His girlfriend left him, he says: "She couldn't take it anymore."

Nearly two years later, with $20,000 invested in the operation and repairs, Mr. Nance says he remains not only permanently scarred but impotent. "This procedure preys on men with little self esteem," he says. "You feel like this is your ticket to happiness." He has sued Dr. Rosenstein and the other surgeon involved in Los Angeles County Superior Court, alleging sexual dysfunction, deformity and fraud and deceit, among other things. Dr. Rosenstein has denied the charges, and an attorney for the other surgeon says the charges are without merit.

More than 50 other lawsuits have been filed by 18 different attorneys against Dr. Rosenstein in Los Angeles County Superior Court. Dennis Grant, an Orange County resident, alleges that he "suffered disfigurement, shortening and loss of use of his penis," while Gary Cates, another former patient, claims he suffered "pain, swelling" and "excessive scarring." Other complaints allege complications ranging from "lumpiness" and "shrinkage" to "uneven surface with what appears to be cysts," and "impotence." In court papers, Dr. Rosenstein has denied the charges.

'Getting Out'

The California Medical Board intervened in January, and Dr. Rosenstein's medical license has been temporarily suspended pending a disciplinary hearing. The surgeon's attorney, Thomas P. Brown, says his client "vigorously contested" the allegations, though he says Dr. Rosenstein won't attempt to re-enter the penile-enlargement business in any case.

"Given the volume of litigation and aggravation associated with it, Dr. Rosenstein is getting out of the business and staying out of it," Mr. Brown says. "But he still maintains he didn't do anything wrong."

Some complaints also began surfacing about at least four other surgeons, who face a growing stack of malpractice suits in California, New Jersey and Illinois courts.

Malpractice insurers sometimes cover physicians who perform the lengthening procedure, but rarely cover them for the fat-injection widening. Mark Gorney, an executive vice president of Napa, Calif., insurer Doctors Co., calls the fat injections "a totally ineffective procedure and nothing short of fraud."

Critics, including some professors of urology, say there is no indication that the lengthening surgery works for everyone, and that fat injections result in too high a degree of deformities. "I challenge them to stop for a minute and show us the results based on preoperative and postoperative measurements," says Harin Padma-Nathan, assistant professor of urology at the University of Southern California. The lengthening operation "appears to be a sham operation to date."

A New Mop-Up Business

Indeed, the industry is so riddled with problems that it is now spawning a mop-up business of its own: An Internet support group for disgruntled patients provides information about surgeons, reconstructions and malpractice suits. At least two California attorneys now specialize in penile malpractice cases. San Francisco attorney Steven Fabbro says he has 30 clients, mostly former patients of Dr. Rosenstein, while Camarillo, Calif., attorney Keith Schulner says he has 35 clients and spends the bulk of his time on the Rosenstein cases.

"This could be the fantastic break that every attorney has ever wanted," Mr. Schulner says. "Or it could be a disappointment. We're going to be clogging up the courthouse for a while."

Repairing allegedly bungled surgeries has also become the main livelihood of Gary Rheinschild, a urologist who operates the Potency Management Center in Anaheim, Calif. His business has nearly doubled this year, he says, to between five and six surgeries a week. About 80% are reconstructions costing $4,500 and the balance are enlargements, costing $7,300 for the lengthening and widening. Beverly Hills urologist Dr. Alter and San Francisco urologist Jack McAninch, the new president of the American Urological Association, also work on botched enlargements.

"A lot of doctors are appalled by this and don't want to talk about it," says Dr. Rheinschild as he pulls on his surgical gown, preparing for a lengthening operation on a 32-year-old aerobics instructor. "But a lot of people are jumping in because of the big money. People shouldn't be doing this unless they know what they're doing."

Dr. Rheinschild says he has seen a lot of complications during the past few years, most of which he says are avoidable. For example, he won't perform fat injections because they often result in "concave areas, nodules and asymmetrical looking penises." He advocates dermal grafts, a different procedure in which two strips of fat are removed from the patient's gluteal folds, where the thighs meet the buttocks, and implanted on either side of the penis.

Hoping for Legitimacy

Hoping to legitimize phalloplasty, several surgeons last year created the American Academy of Phalloplasty Surgeons. But so far only about a dozen surgeons have joined, and the academy hasn't yet published any scientific studies. One member, E. Douglas Whitehead, has received approval to begin a study at Beth Israel Medical Center in New York.

Despite the horror stories, though, the business shows no signs of slowing. Even Dr. Rosenstein's colleagues are already back in the saddle. It turns out that Cosmetic Surgery International, the outfit that uses the slick promotional videotape and is booked through July, is co-owned by Dr. Rosenstein's stepson, Jonathan Yaker, along with Christopher Solton, who is Dr. Rosenstein's former marketing director. Promotional literature CSI recently mailed out displays the name "Rosenstein Medical Group" and features flattering newspaper articles about the surgeon.

Mr. Solton, the co-owner, insists that Dr. Rosenstein has nothing to do with CSI. "It must have been an old folder," he says. "It was a mistake." Dr. Rosenstein's attorney, Mr. Brown, says he has notified CSI that the surgeon can no longer be referred to in the clinic's materials.

Other phalloplasty practitioners say the procedure isn't going away because, quite simply, the time is right for it. The surgery ties into the American male psyche, they say, making for possibilities that aren't only lucrative but limitless.

"You've had a few people who have done large numbers with bad results," Dr. Alter in Beverly Hills says. "But in 10 years, as improvements are made, you'll see this surgery becoming mainstream. It's a vain society out here."